Healthcare Provider Details

I. General information

NPI: 1760332936
Provider Name (Legal Business Name): ADRIA JEAN CODISPOT LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11676 PERRY HWY STE 2100
WEXFORD PA
15090-7203
US

IV. Provider business mailing address

111 PINEVIEW RD
BADEN PA
15005-9667
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-7722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC002619
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: